Your View: 'Death panel' a loaded term, but not inaccurate

Wednesday

Apr 24, 2013 at 12:01 AM

Cass Sunstein makes a solid point in his recent editorial on the tendency of politically knowledgeable people to be impervious to arguments from opponents — both right-wingers and left-wingers tend to assign evil intentions to opponents and too often ignore the content of their arguments.

LEE NASON

Cass Sunstein makes a solid point in his recent editorial on the tendency of politically knowledgeable people to be impervious to arguments from opponents — both right-wingers and left-wingers tend to assign evil intentions to opponents and too often ignore the content of their arguments.

But the research that led Sunstein to make this observation is, I believe, fatally flawed.

This is because the new Affordable Care Act does indeed mandate what might legitimately be called a "death panel." I would argue that politically knowledgeable conservatives and libertarians were inclined to ignore the editorial correction ("nonpartisan health care experts have concluded that Palin is wrong") because they already knew that Palin's statements were incorrect but that a "death panel" was indeed included in the bill.

Before anyone "writes off" my assertions as biased or motivated by racist hatred for Obama or whatever, we need to look at some hard facts about health care and the Affordable Care Act.

First, the non-partisan health care experts were correct: Palin was wrong. She was criticizing the ACA-mandated encouragement for end-of-life counseling. Such counseling does not qualify as a "death panel" and, in fact, is something that all of us should participate in regardless of our personal discomfort about contemplating our own inevitable deaths.

But the ACA does establish the Independent Payment Advisory Board. This group of 15 unelected individuals, appointed by the president, is answerable to no one. They are tasked with a single objective — to reduce the per capita rate of growth of Medicare spending. They must do this by deciding precisely which health care treatments, procedures and standards will be covered and which will not. But since deciding whether a particular test, treatment plan or medication is required for a given patient is not an exact science (and may well depend on the individual medical and genetic background of the patient), necessarily they will be denying coverage for at least some people who could be helped by the treatment that they have banned.

In some cases, this will mean that needless deaths will occur. As citizens and patients, we have no knowledge of how serious this problem may be — the "rules" haven't yet been written. Worse, citizen-patients will have no input into what the "rules" would be. Worse still, virtually all of us who live to retirement age will be affected by the "rules" that are to be established.

Advocates for the ACA might well try to ignore the possible implications of the IPAB — the president will surely veto anything that might result in an unnecessary death of a citizen. But several pieces of evidence suggest that these advocates would be mistaken.

The first piece of evidence concerns recent moves by health care officials to reduce Medicare costs by cutting back of preventive screenings for breast cancer and prostate cancer. While one might reasonably believe that we do too much screening now and that there are too many false positives, these screenings do actually detect some cancers in early stages and therefore do actually save some lives. Whether to get such screenings should be a decision made between informed patients and their doctors — not by the IPAB.

A second piece of evidence concerns the recent moves by health care officials to delay approval of some innovative treatments like bone marrow transplants (only recently approved for coverage) or reject reimbursement for some expensive medications like avastin (which is only slowly gaining approvals for treatment of various cancers from the FDA). While some of the concerns about the safety and efficacy of these controversial medications and treatments are quite legitimate, the decision to use them should again be made between an informed patient and his or her doctor — not the IPAB.

But probably the most damning piece of evidence comes from the fully nationalized health care system in the United Kingdom. The role of the IPAB under the ACA is virtually identical to the role of the United Kingdom's National Institute for Comparative Effectiveness. But the World Health Organization Eurocare 2 Study indicates that 25,000 premature deaths occur each year in the United Kingdom because NICE delays and denies treatments that are available in other European countries. Any medical board that causes the unnecessary deaths of 25,000 people a year certainly deserves to be called a "death panel."

So the question of whether or not the ACA includes death panels is still not completely resolved but the evidence all suggests that the IPAB will, in fact, become a death panel for many Americans. Anyone who knows the evidence would surely not be dissuaded from using the term "death panels" when discussing the Affordable Care Act, regardless of Sarah Palin's mistaken beliefs.

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